When the Brighton Sanitary Committee began discussing plans for an isolation hospital in 1879, the only place to treat cases of smallpox was the workhouse in Elm Grove, a fact about which the Guardians of the Poor, who has responsibility for the workhouse, were not happy. Smallpox is a highly infectious disease, so as soon as cases were diagnosed the patients had to be removed from circulation until they recovered or died.
A 10-acre site was acquired by April 1881 on the other side of Bear Road from the cemetery and plans were drawn up for a permanent sanatorium, to be known as the Brighton Borough Hospital, with 50 beds. But before construction could begin an outbreak of smallpox necessitated the construction on the Bevendean site of a makeshift wooden structure with felt-covered roof and open-sided walkways. It consisted of two pavilions, each with separate wards for men and women, plus facilities for medical staff, administration, a kitchen and dispensary.
Early the following year an even more temporary structure of wood and corrugated iron that had been used during the Brighton Health Congress was moved to the site. This was big enough to form six wards to take cases of scarlet fever and diphtheria that were not admitted to other hospitals. In fact, despite the rudimentary nature of the facilities, Brighton was in the forefront among towns that established isolation hospitals. As late as 1893, there were only 28 such hospitals outside London and only 10, including Brighton's, deemed adequate for the size of the local population.
In 1888 Dr Arthur Newsholme was appointed Medical Officer of Health for Brighton and by the end of the year took over the additional post of Medical Officer of the Sanatorium. He found the sanatorium in dilapidating condition and unfit for purpose. It took two years for agreement to be reached on the need for a new hospital on the Bevendean site and it was not until June 1896 that the Local Government Board (LGB) approved funding. The first patients were admitted in March 1898 and the official dedication of the building by the mayor, Sir John Blaker, took place on 27 October that year.
Further buildings were added between 1902 and 1905 but it was never necessary to add all the buildings included in the original plans. However, the LGB stipulated that a facility for treating smallpox should not be within half a mile of any inhabited place. So it imposed a condition on funding that smallpox cases were not to be admitted to the new hospital, which was less than half a mile from Preston Barracks,the Elm Grove workhouse and the streets that had developed around Bear Road.

So what happened to smallpox patients? The incidence of cases had been reduced considerably and were now rare in Brighton, an achievement that Newsholme attributed to the vaccination programme, although slum clearance had played a significant part. Nonetheless, the risk remained and was potentially increasing, not least as a change in the law allowed parents to refuse vaccination for their children. There was a serious outbreak in 1902-03, during which chickenpox was made a notifiable disease locally to ensure that more smallpox cases could be traced.
The LGB urged local authorities to collaborate on joint projects for isolation hospitals but Brighton decided to act alone. The Corporation bought a farm on Fulking Hill near Devil's Dyke and turned the farmhouse and its barn into a part-time hospital, known as Fulking Grange.

Fulking Grange
Because the Brighton Sanatorium at Bevendean was too close to built-up areas for highly infectious diseases, Brighton Council bought a farm on Fulking Hill near Devil's Dyke in 1901 and converted the farm buildings into an isolation hospital, known as Fulking Grange, for smallpox cases. The 12-room farmhouse became the administration block and the barn was converted into two wards, each with room for 12 patients. If more accommodation were needed, two portable huts could be erected on a concrete slab to house four more patients.
The hospital had a resident caretaker but was only opened up when an outbreak occurred. There was no electricity supply and water was collected in rainwater cisterns, although the wards had hot-water radiators. Importantly, in view of the risk of contagion, a telephone line was run up to the site. Nurses were sent up from the sanatorium in Bevendean or specially hired for as long as needed. The first smallpox patients were transferred to Fulking Grange at the start of the outbreak in 1902.
The ruins of Fulking Grange remain on top of the escarpment, due south of the Shepherd and Dog pub and only a few yards away from the well-worn path along the ridge.